| NPI | 1922444397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 266457) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 266457) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2019-12-12 |