| NPI | 1801008560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA07101500) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01071714A) |
| 208D00000X General Practice (Licence: PA MD423776) | |
| 208D00000X General Practice (Licence: NJ 25MA07101500) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2015-05-27 |