| NPI | 1114181963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0200X Clinic/Center Radiology (Licence: NJ 25MA09996500) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 256839) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2017-01-24 |