| NPI | 1447563168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 280642) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD441968) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 250390) | |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2023-11-02 |