| NPI | 1578525226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD431395) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08317200) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD431395) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA08317200) | |
| 2085B0100X Radiology Body Imaging (Licence: PA MD431395) | |
| 2085B0100X Radiology Body Imaging (Licence: NJ 25MA08317200) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2013-08-16 |