| NPI | 1104872894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: NJ 25MA07990300) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07990300) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: NJ 25MA07990300) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-08 |