| NPI | 1720016595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101267499) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA70641) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101267499) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-09-17 |