| NPI | 1376500512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07994500) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD428719) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-09-30 |