| NPI | 1689706434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09179300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.012530) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2011015956) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2012-09-15 |