| NPI | 1609197078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 262519) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09722200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD451918) | |
| Enumeration Date | 2010-06-19 |
| Last Update Date | 2016-03-28 |