| NPI | 1275673741 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA03517900) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 205501-01) |
| 261QR0200X Clinic/Center, Radiology (Licence: NJ 23294) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-02-07 |