| NPI | 1104913524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08199300) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: PA MD429887) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 238831) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2016-10-26 |