| NPI | 1932468519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD475819) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD475819) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: PA 25MA11346000) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11346000) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2024-08-28 |