| NPI | 1851565543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 245357) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 245357) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2021-10-01 |