| NPI | 1033346499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 278572) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-17196) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: AR E-17196) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2024-02-20 |