| NPI | 1366839292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11115500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 303203) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2021-10-01 |