| NPI | 1487819553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0027560) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08841800) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V4279) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2024-12-09 |