| NPI | 1174579973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD032885E) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NJ 25MA08755700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0009494) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-03-07 |