| NPI | 1568568301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 170370) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 206132) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P1952) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-04-18 |