| NPI | 1609352491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 326760) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 326760) |
| 208600000X Surgery (Licence: PA MT217037) | |
| Enumeration Date | 2018-07-14 |
| Last Update Date | 2025-07-28 |