| NPI | 1891766689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 170474-1) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 170474-1) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NY 170474-1) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2013-09-13 |