| NPI | 1578795290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 89702) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 298316) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 298316) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2023-08-15 |