| NPI | 1154304434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 262720) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24386) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2011-11-30 |