| NPI | 1508805805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 236276) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA08625100) |
| 2086S0129X (Licence: NY 236276) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2026-06-18 |