| NPI | 1376741157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A109880) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09906500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 226375) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2021-01-13 |