| NPI | 1972991529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD031238L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 109243-1) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |