| NPI | 1518249291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT223355) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03388400) |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2021-06-14 |