| NPI | 1699085860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09528600) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09528600) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 258977) | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2020-08-27 |