| NPI | 1619014107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: NY 208269) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 208269) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-09-07 |