| NPI | 1912004698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 269557) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A86769) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2019-04-11 |