| NPI | 1750692075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD044221) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301096907) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11827400) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2023-07-10 |