| NPI | 1679763692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 252255) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A93069) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2012-01-04 |