| NPI | 1578717732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08546900) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NJ 25MA08546900) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2014-11-25 |