| NPI | 1912266974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS 12043) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 273834) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2021-06-02 |