| NPI | 1417902883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08388500) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 44640) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 47786) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2008-07-03 |