| NPI | 1366510620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 242484) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 242484) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2026-01-07 |