| NPI | 1205871431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA075592) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M9216) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M9216) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2017-02-02 |