| NPI | 1679590319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11085100) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NJ 25MA11085100) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61156101) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-05-20 |