| NPI | 1023302346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A160018) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 274773) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2019-06-28 |