| NPI | 1114916921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 48492) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 236284) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2021-04-22 |