| NPI | 1407169436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 245519-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 84875) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2026-07-08 |