| NPI | 1104824606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 172604-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 172604) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2017-02-14 |