| NPI | 1518279082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10566000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 292782-1) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2019-09-11 |