| NPI | 1497951719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 29732) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA12501800) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TPME7404) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA12501800) | |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2025-10-09 |