| NPI | 1548425978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ MA42736) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 152130-1) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD417556) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 31238) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |