| NPI | 1760832406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11328600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210962) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-05-11 |