| NPI | 1700985884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA04183000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04183000) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-02-23 |