| NPI | 1467661686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME105179) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ ME59223) |
| 2085N0904X (Licence: NJ 07858) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2026-02-19 |