| NPI | 1215476155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11736900) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 31198) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2023-03-16 |