| NPI | 1295912483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8701) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230130) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2025-08-27 |