| NPI | 1366646416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P8223) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NJ 25MA09187400) |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 249640) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2026-05-14 |