| NPI | 1972836401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: NY 260077) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MA 232117) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2014-06-24 |