| NPI | 1073774246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD436438) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PA MD436438) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 25MA08788500) | |
| 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA08788500) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2015-09-28 |