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 |