| NPI | 1639176084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA06501100) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD070556L) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD070556L) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA06501100) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2011-01-18 |