| NPI | 1629455076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 060.0005185) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 339717) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0018973) | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2025-11-17 |