| NPI | 1669679544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10991000) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NY 247109) |
| 2085N0700X Radiology Neuroradiology (Licence: NJ 25MA10991000) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-05-17 |