| NPI | 1538163985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 126687) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: KY 37675) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 37675) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101-242529) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2016-04-29 |