| NPI | 1073572020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA0783300) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD043976L) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D0063319) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-04-29 |