| NPI | 1457614141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10336900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT202262) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-03-27 |