| NPI | 1710335633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 298428) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03746) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2022-07-28 |