| NPI | 1427054766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD048970-L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA05903700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME164488) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2024-04-26 |