| NPI | 1053589549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24581) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 37694) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 245480-1) | |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2010-12-15 |