| NPI | 1114152949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 277156-1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 277156-1) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2015-05-06 |