| NPI | 1114047040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 42998) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 237358-1) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 104269) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2011-10-14 |