| NPI | 1477045029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 322233) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 5014058) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2023-04-17 |