| NPI | 1275722977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD439930) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08766900) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD439930) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA08766900) | |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2013-02-15 |