| NPI | 1003812413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD026979E) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA04419500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0009758) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2012-08-24 |