| NPI | 1154598480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA10015600) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD443009) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10015600) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD443009) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2019-12-04 |