| NPI | 1720647787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 307484) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 100760-01) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 5MA11699600) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-05-04 |