| NPI | 1104879857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 175063) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 175063) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2015-01-07 |