| NPI | 1841636420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD470888) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11274500) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2021-10-14 |