| NPI | 1063624468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260098-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 14885) | |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2013-09-16 |