| NPI | 1629154984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA04101000) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35082176) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 159146) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA04101000) | |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2021-09-28 |