| NPI | 1225396922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 295774) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4994-320) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2024-12-20 |