| NPI | 1124161872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09610500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM TM2014-0943) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 164449) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 53879) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G70226) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2026-05-29 |