| NPI | 1013586700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0040306) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 344181) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2026-06-18 |