| NPI | 1346203759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M9521) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 176241) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2008-10-02 |