| NPI | 1497295588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 1013335) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 298767) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 298767) | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2023-02-07 |