| NPI | 1003871872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D28008) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D28008) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04060600) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2023-01-30 |