| NPI | 1407896731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 224797) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 224797) |
| 2085R0205X Radiology, Radiological Physics (Licence: NY 224797) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2015-01-07 |