| NPI | 1831454867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD459076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10161400) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD459076) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA10161400) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-03-28 |