| NPI | 1013997428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ MAO73422) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07342200) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 194240) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2017-02-24 |