| NPI | 1891061420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-02153) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10744300) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD460445) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2022-01-04 |