| NPI | 1003871823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 53664) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA066296600) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 204291) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-04-13 |