| NPI | 1225052285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME97339) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME97339) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 153691-01) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08178100) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD044591L) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-10-15 |