| NPI | 1194088518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 273850) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN17989) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2014-10-14 |