| NPI | 1790984607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260657) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301087094) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 6456) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2024-01-31 |