| NPI | 1639278591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD442738) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2008021985) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10295900) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-01-16 |