| NPI | 1114480613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA12462900) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 77148) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2025-08-09 |