| NPI | 1679897185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 255874-1) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NY 255874-1) |
| 2085R0203X Radiology Therapeutic Radiology (Licence: NY 255874-1) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: NY 255874-1) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA0942030) | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2015-03-26 |