| NPI | 1871692806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP285) |
| Additional Taxonomies | 2085N0700X (Licence: NJ 25MA05317000) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05317000) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-05-08 |