| NPI | 1407828775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 132532) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: NY 132532) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2008-08-08 |