| NPI | 1467413948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301046101) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 224226) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2023-07-06 |