| NPI | 1891775755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25ma07086700) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0063910) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE CP006) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 15411C) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-06-22 |