| NPI | 1922070457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 246302) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 246302) |
| 174400000X Specialist (Licence: PA MD067418L) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD067418L) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-08-24 |