| NPI | 1316149172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q0337) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09210300) |
| 2085N0700X Radiology, Neuroradiology (Licence: NJ 25MA09210300) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2016-11-17 |