| NPI | 1497776033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0009182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 161407) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2025-06-06 |