| NPI | 1841492873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ MA08627900) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: RI LP01129) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-02-11 |