| NPI | 1811396377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 301045) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 301045) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2020-09-16 |