| NPI | 1770569378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA07808800) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD423505) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2018-04-20 |