| NPI | 1528089166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0008332) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 042-0008332) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 246680) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-03-04 |