| NPI | 1932462629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 55345) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 267561) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-09-07 |