| NPI | 1518256213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: PA MD449783) |
| Additional Taxonomies | 2085N0700X (Licence: NJ 25MA10387100) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD449783) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10387100) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2025-04-21 |