| NPI | 1598979544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0009672) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ NA) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2013-04-03 |