| NPI | 1629352083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10358400) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD458060) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2018-07-19 |