| NPI | 1912984238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 167074) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05592600) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2019-10-16 |