| NPI | 1710341961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO CDR0004239) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR0004239) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 312877) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2025-01-22 |