| NPI | 1770785321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME155402) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230185) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2022-03-28 |