| NPI | 1609198779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: NY 276012-1) |
| Additional Taxonomies | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: NJ 25MA09637400) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 276012-1) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09637400) | |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2020-08-13 |