| NPI | 1669745576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME131804) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 270145) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2022-07-21 |