| NPI | 1033407499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301099446) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 331821) |
| 208D00000X General Practice (Licence: MI 4301099446) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2024-08-26 |