| NPI | 1447490784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 268668) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 390200000X) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2025-09-11 |