| NPI | 1720302706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 167433) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 253851) |
| Enumeration Date | 2010-03-20 |
| Last Update Date | 2024-10-02 |