| NPI | 1154654739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 49386) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT AS3501233) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 267307) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2015-12-15 |