| NPI | 1083277636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: NJ 25NB12571000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MB12571000) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2025-07-03 |