| NPI | 1588869655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09100000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 253537) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2014-06-30 |