| NPI | 1629170782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: NJ 25MA05941500) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NJ 25MA05941500) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA05941500) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: NJ 25MA05941500) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |