| NPI | 1265775928 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25IA12267700) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.136086) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.136086) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2024-10-08 |