| NPI | 1578779310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA08603400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ N-A) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2012-07-26 |