| NPI | 1700203064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA10818600) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10818600) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2021-01-15 |