| NPI | 1700083763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09005400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 263394) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-07-26 |