| NPI | 1740677053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0024311) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0024311) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA11897500) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2023-07-11 |