| NPI | 1285852467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 242871) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 39966) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2008-07-14 |