| NPI | 1154327013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA 05834200) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD 059009-L) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2024-01-21 |