| NPI | 1144317793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD472345) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 169883-1) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA06711200) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 75201) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2023-07-21 |