| NPI | 1912147067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: PA D008829) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA09024700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09024700) | |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2020-09-01 |