| NPI | 1821197666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08166200) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 203708) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA08166200) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-01-04 |