| NPI | 1336140920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MB06159000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS004560L) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2007-09-26 |