| NPI | 1356448773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 062399L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05686200) |
| 174400000X Specialist (Licence: NJ 25MA05686200) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-09-03 |