| NPI | 1841256153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 215583) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G7829) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2014-11-04 |