| NPI | 1578703153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME163367) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 003835) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX R8516) | |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2025-01-15 |