| NPI | 1265421697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07852700) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 2319781) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2008-04-04 |