| NPI | 1780899849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD445712) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264562) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09174300) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2013-08-14 |