| NPI | 1477535763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 240680) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 211729) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2021-03-13 |