| NPI | 1336391416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D76334) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 250233) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD040721) | |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-10-04 |