| NPI | 1376863878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 274607-1) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10184200) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A134617) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2021-09-08 |