| NPI | 1255301883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD423723) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NJ 25MA07169800) |
| 2085B0100X Radiology Body Imaging (Licence: PA MD423723) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07169800) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2020-03-13 |