| NPI | 1487966693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 284781) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 261460) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2016-07-05 |