| NPI | 1205872017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 232776) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 18587) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-09-30 |