| NPI | 1043297195 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX G3923) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 234251) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-11-19 |