| NPI | 1689678039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA06658000) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NJ 25MA06658000) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2011-10-07 |