| NPI | 1457305195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 198885) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200501192) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 198885) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-07-03 |