| NPI | 1376600064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10134900) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61344569) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0102507) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2025-05-29 |