| NPI | 1356784490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 79212) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 294024) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2024-10-10 |