| NPI | 1801876172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD015368E) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PA MD015368E) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04153200) | |
| 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA04153200) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2016-01-21 |