| NPI | 1063470920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0208X Clinic/Center, Radiology, Mobile (Licence: NJ 626344) |
| Additional Taxonomies | 261QR0208X Clinic/Center, Radiology, Mobile (Licence: NY 092842) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2025-10-02 |