| NPI | 1578925665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 313467) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11438100) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2025-03-25 |