| NPI | 1366739245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 284965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 39) |
| 2085B0100X Radiology, Body Imaging (Licence: PA OS018010) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2023-07-03 |