| NPI | 1699054601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 297535-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 1.055285) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-48035) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2023-08-03 |