| NPI | 1790016020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 288512) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD438629) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2017-06-23 |