| NPI | 1114128204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: PA MD442315) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA13004300) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2026-05-19 |