| NPI | 1902005093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08594600) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 231754) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101244012) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2014-02-05 |