| NPI | 1962409953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME162079) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD430274) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 214170) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08301000) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2023-11-20 |