| NPI | 1245255538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 142645) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NY 142645) |
| 2085N0904X Radiology Nuclear Radiology (Licence: NJ 25MA06659900) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA06659900) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-12-05 |