| NPI | 1215377981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2025-0973) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 278553) |
| 207R00000X Internal Medicine (Licence: MA 255564) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA12893800) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2025-11-11 |