| NPI | 1104125517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 279220) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10199100) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2024-06-05 |