| NPI | 1821073677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: NJ 25MA06819200) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA06819200) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2011-01-05 |