| NPI | 1477873065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 304602) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 48620) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP495) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 53158) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2022-04-26 |