| NPI | 1538363114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA11142000) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M5901) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX M5901) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA C176259) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2023-11-29 |