| NPI | 1700936788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 111462) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 111462) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |