| NPI | 1518906726 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 2085R0202X) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 208737) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 208737) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-12-03 |