| NPI | 1215907175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD045278L) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: PA MD045278L) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA06360600) | |
| 2085B0100X Radiology Body Imaging (Licence: NJ 25MA06360600) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2016-01-20 |