| NPI | 1811438187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MB11614400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 312763) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-07-11 |