| NPI | 1992238570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 320084) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: TX V9769) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA11905300) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2026-04-28 |