NPI | 1467789164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0003797) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA03331100) |
2085R0202X Radiology, Diagnostic Radiology (Licence: NY 112501-1) | |
Enumeration Date | 2009-11-17 |
Last Update Date | 2009-11-17 |