| NPI | 1376892786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 295960) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NY 295960) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2020-01-22 |