| NPI | 1942255450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME143165) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 156669-1) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05344200) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-02-03 |