| NPI | 1003968660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A8561) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 223520) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2017-02-10 |