| NPI | 1699040790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 157673) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269794) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 282517) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 282517) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2024-01-07 |