| NPI | 1124345046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A119701) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 254399) |
| Enumeration Date | 2010-05-02 |
| Last Update Date | 2021-11-30 |