| NPI | 1942663414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 80087) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 301190) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-01-26 |