| NPI | 1568818094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11953200) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 311172-01) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2023-10-26 |