| NPI | 1609030758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MB09085200) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 045997) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CT 045997) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA OS015891) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2024-10-01 |