| NPI | 1194808717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04896600) |
| Additional Taxonomies | 2471B0102X Radiologic Technologist, Bone Densitometry (Licence: NJ MA048966) |
| 2471C3402X Radiologic Technologist, Radiography (Licence: NJ MA048966) | |
| 2471M2300X Radiologic Technologist, Mammography (Licence: NJ MA048966) | |
| 2471S1302X Radiologic Technologist, Sonography (Licence: NJ MA048966) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-01-10 |