| NPI | 1609118710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 339293) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65173) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2026-08-12 |