| NPI | 1073582557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS013100) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 213740-1) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2021-03-12 |