| NPI | 1558367268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04956000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD046248L) |
| 2085B0100X Radiology, Body Imaging (Licence: PA MD046248L) | |
| 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA04956000) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2015-05-07 |