| NPI | 1174667034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D96465) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD163925) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10161700) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2023-07-13 |