| NPI | 1023055654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05700500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 80682) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-09-30 |