| NPI | 1811901135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 2526031) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 2526031) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 252603) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2023-07-06 |