| NPI | 1588168868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 301409) |
| Additional Taxonomies | 2085N0700X (Licence: NJ 25MA12628600) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-06-26 |