| NPI | 1780062687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 304468) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 268396) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2021-12-01 |