| NPI | 1336160159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0009300) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 176919) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-12-07 |