| NPI | 1508842808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: NY 191697) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 191697) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2013-07-18 |