| NPI | 1578679551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 0000059739) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: GA 060412) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA07883000) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 060412) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07883000) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 235892-1) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 235892-1) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-08-05 |