| NPI | 1992932636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA09165600) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 246585) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09165600) | |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2016-12-15 |