| NPI | 1104845916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 246993-1) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ MA41619) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: NJ MA41619) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-02-25 |