| NPI | 1760490452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08164300) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME56380) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2025-07-01 |