| NPI | 1275782849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 245913) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: PA 437260) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2010-07-26 |