NPI | 1174503700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD036663E) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08152800) |
2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA08152800) | |
2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD036663E) | |
Enumeration Date | 2006-01-19 |
Last Update Date | 2016-01-21 |