| NPI | 1740546951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10274400) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: DE C1-0012460) |
| 2085N0700X Radiology Neuroradiology (Licence: PA MD463235) | |
| 2085N0700X Radiology Neuroradiology (Licence: NJ 25MA10274400) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD463235) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0012460) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2019-05-13 |