| NPI | 1952622680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA11858900) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT196605) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-07-16 |