| NPI | 1104263110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11947400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD464796) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.063193) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-12-07 |