| NPI | 1952419095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NY 220523) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 220523) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 044692) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 044692) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 220523) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2021-02-24 |