| NPI | 1538209895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08591500) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D63811) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2009-09-21 |