| NPI | 1750547386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 260730) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD438193) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD438193) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA08811900) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260730) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2013-02-05 |