| NPI | 1770569063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07914600) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NJ 25MA07914600) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2011-01-11 |