| NPI | 1205194941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: NY 272080-1) |
| Additional Taxonomies | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: NJ 25MA09133300) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09133300) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 272080-1) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2018-08-07 |