| NPI | 1861796948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD172714) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 259887) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A131287) | |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2017-01-26 |