| NPI | 1265829527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME165586) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 314571) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2024-03-18 |