| NPI | 1780664755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD013584E) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: PA MD013584E) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA06001000) | |
| 2085B0100X Radiology Body Imaging (Licence: NJ 25MA06001000) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2016-01-19 |