| NPI | 1144591801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 292428) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 252113) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2020-01-31 |