| NPI | 1649276387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ MA05183900) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA05183900) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD031213-E) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD031213E) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2012-08-24 |