| NPI | 1154515294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 229127) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08308400) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD431205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 23362-875) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2022-12-07 |