| NPI | 1326276866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264206) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 59598) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2025-11-14 |