| NPI | 1740635036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA11354900) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 292350) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2022-06-15 |