| NPI | 1174819429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10020400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199644) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2017-11-22 |