| NPI | 1851704514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 308629) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT 206057) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2023-03-30 |