| NPI | 1255547717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0009504) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08264200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 274641) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD425582) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-08-29 |