| NPI | 1376522409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD420133) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08154400) |
| 2085B0100X Radiology, Body Imaging (Licence: PA MD420133) | |
| 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA08154400) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2016-01-19 |