| NPI | 1205010600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 7162) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230723) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2021-03-02 |