| NPI | 1760480586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07182500) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 215 737-1) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2023-12-04 |