| NPI | 1447557996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114445) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 244625) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2015-10-12 |