| NPI | 1396164992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10862500) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA10862500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 77993) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2024-11-17 |