| NPI | 1891897617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 141442) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07673300) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 31689) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 041448) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A23570) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD041298E) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-12-06 |