| NPI | 1497895056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07859600) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD425889) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2014-06-10 |