| NPI | 1417989682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101044480) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 233752) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08982700) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-05-19 |