| NPI | 1831154301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 220183) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: KY C1140) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C1140) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY C1140) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2025-01-10 |