| NPI | 1447561261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 263704) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 261485) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2023-05-24 |