| NPI | 1962638056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 288048) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 39717) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2017-06-06 |