| 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 |