| NPI | 1538450010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 286933) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 253272) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2023-06-14 |