| NPI | 1770716276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A129486) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 261101) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2014-06-27 |