| NPI | 1265415038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 114166) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NJ 25MA03219200) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NY 114166) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA03219200) | |
| 261QM1200X Clinic/Center, Magnetic Resonance Imaging (MRI) (Licence: NY 114166) | |
| 261QM1200X Clinic/Center, Magnetic Resonance Imaging (MRI) (Licence: NJ 25MA03219200) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2007-10-24 |