| NPI | 1942315163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 192230) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NJ 25MA06920400) |
| 2085N0700X Radiology, Neuroradiology (Licence: NY 192230) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA06920400) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-08-02 |