| NPI | 1386878452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 050211) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2014008386) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 302851) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 050211) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2021-06-01 |