| NPI | 1801802962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08818200) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 251602) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-02-01 |