| NPI | 1922020262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA OS006396E) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MB05487400) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MB05487400) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |