| NPI | 1164868782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101264582) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10511200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0082184) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2021-05-05 |