| NPI | 1508187246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA10883200) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT198109) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-09-29 |