| NPI | 1891083150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10177600) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 287998) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2018-06-27 |