| NPI | 1134652753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A175798) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11628400) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 76491) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2025-10-29 |