| NPI | 1992333041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 318501) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT221517) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2022-07-25 |