| NPI | 1689137762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA12732000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2021020973) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD489641) | |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2025-10-10 |