| NPI | 1174729974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08401000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2007-00771) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD447532) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2019-03-28 |