| NPI | 1710038765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD431857) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07709300) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00042567) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 213290) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2019-12-09 |