| NPI | 1760422232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 06233100) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 182564) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 182564) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2021-07-22 |