| NPI | 1609849546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 224460) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07506300) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL 75179) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA07506300) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2020-10-31 |