| NPI | 1912133109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA09688800) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 275287) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-07-15 |