| NPI | 1174816003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 54871) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 288710) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2018-10-09 |