| NPI | 1639151632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA0523800) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NJ 25MA05923800) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2011-01-06 |