| NPI | 1962665620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 86745) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09619100) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09619100) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-06-16 |