| NPI | 1609838663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 135391-1) |
| Additional Taxonomies | 2085N0904X (Licence: NY 135391-1) |
| 207U00000X Nuclear Medicine (Licence: NY 135391) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2008-04-14 |