| NPI | 1386820587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA OS017617) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 275165) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS017617) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 275165) | |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2022-01-03 |