| NPI | 1619118932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 291674-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD443993) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0010021) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09090500) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0010021) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09090500) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD443993) | |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2018-08-16 |