| NPI | 1568662369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q0710) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 276345) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2025-11-30 |