| NPI | 1154399657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD423493) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 234501-1) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2007-10-24 |