| NPI | 1790755304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NJ 25MA09125200) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD445713) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: NC 149730) | |
| 208D00000X General Practice (Licence: CA A88231) | |
| 208D00000X General Practice (Licence: VA 0101239916) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-05-22 |