| NPI | 1235231051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 194752) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA07569300) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 31419) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 041174) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-07-08 |