| NPI | 1982992657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA04459600) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 097019-1) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2011-07-15 |