| NPI | 1770671075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ MA076436) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD019361E) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2014-08-12 |