| NPI | 1518175637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D65836) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 53333) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08371500) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-14124) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2024-10-03 |