| NPI | 1316201700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA10322500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0012579) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD463666) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0012579) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463666) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10322500) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2018-08-28 |