| NPI | 1053498147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 16221) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 213546) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 216852-1) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-08-11 |