| NPI | 1053679902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD461409) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT205152) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10104300) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2018-09-20 |