| NPI | 1235149618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08131200) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D51451) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 056693) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-07-09 |