| NPI | 1093909483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD600001793) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA08286900) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0101212) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 207998) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2024-08-15 |