| NPI | 1609939735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME124555) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD431814) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 232386) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD431814) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 232386) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2022-01-21 |