| NPI | 1679899645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA09823700) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301095904) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2021-03-19 |