| NPI | 1003115155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME114125) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 256879) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2019-08-20 |