| NPI | 1427097500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD021520E) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PA MD021520E) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05000400) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-01-30 |