| NPI | 1063625291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 255485) |
| Additional Taxonomies | 2085N0904X (Licence: NY 255485) |
| 2085N0904X (Licence: NJ 25MA08330400) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08330400) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-11-21 |