| NPI | 1073621702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 233511) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07751200) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA07751200) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-12-10 |