| NPI | 1578721593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101242425) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 246121) |
| 174400000X Specialist (Licence: NY 246121) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09064100) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2013-10-17 |