| NPI | 1912075631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2014-02064) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230324) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-02064) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2023-11-19 |