| NPI | 1811965502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 180453-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 180453) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2023-06-29 |