| NPI | 1225560063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 323663) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 323663) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA13222100) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA13222100) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2026-07-23 |