| NPI | 1558322180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G52631) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 224686-01) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2024-03-13 |