| NPI | 1023158649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX P2230) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 242976) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08382500) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA08382500) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2016-02-04 |