| NPI | 1962499418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 263633-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07578300) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI 10655) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-10-28 |