| NPI | 1659387470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 042-0010965) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 0420010965) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 242243) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-11-20 |