| NPI | 1639194921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 195086) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NJ 25MA07152200) |
| 2085N0700X Radiology Neuroradiology (Licence: NY 195086) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07152200) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-07-22 |