| NPI | 1801215868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 042-0015105) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME147398) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME147398) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 315454) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2022-05-18 |