| NPI | 1841426558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD455810) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD455810) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09751900) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09751900) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0011452) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0011452) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2015-08-26 |