| NPI | 1235490194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101026569) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A17746) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11631200) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2024-11-18 |