| NPI | 1225070121 |
|---|---|
| Other Name | JACK LAWRENCE BALDASAR |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA3606000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 124001-1) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2009-12-15 |