| NPI | 1396066932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 273276) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 273276) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: NY 273276) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 273276) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2014-07-07 |