| NPI | 1710202536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 58699) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08782500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 256568) | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2022-03-08 |