| NPI | 1750365524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 110393) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 183965) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD056898L) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD056898L) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2026-02-11 |