| NPI | 1871029538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 322566) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 309899) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2024-03-27 |