| NPI | 1942207030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD022495E) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA04799900) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2012-08-24 |