| NPI | 1154669380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 269705-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 269705) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 51903) | |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2018-03-17 |