| NPI | 1710097001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00049132) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 203294) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 203294) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-10-16 |