| NPI | 1669823175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 246317) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 60246317) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-08-18 |