| NPI | 1720266695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 80029) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 002758) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264154-1) | |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2023-06-26 |