| NPI | 1790958064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036.120054) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD50346) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 50346) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 260610) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2021-05-21 |