| NPI | 1538428453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13613) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09451500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101286266) | |
| Enumeration Date | 2012-05-12 |
| Last Update Date | 2026-02-19 |