| NPI | 1790745743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 201299) |
| Additional Taxonomies | 2085N0700X (Licence: NY 201299) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2025-03-23 |