| NPI | 1396090866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U0402) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 285360) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2023-01-30 |