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