| NPI | 1114989167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 178746) |
| Additional Taxonomies | 2085N0700X (Licence: NY 178746) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2008-04-14 |