| NPI | 1104869791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04006500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 135080-1) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-01-14 |