| NPI | 1023136322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 47763) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 247951) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08601800) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2018-09-14 |