| NPI | 1285959650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA10425000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10425000) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD457710) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2019-05-13 |