| NPI | 1811192164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2008-00768) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 237548) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-09-18 |