| NPI | 1720456049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 128919) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 2010966 PTAL) |
| 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: NC CCI: 00093517) | |
| 2471S1302X Radiologic Technologist, Sonography (Licence: MD ARDMS: 176911) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2020-08-08 |