| NPI | 1174594816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 147116-1) |
| Additional Taxonomies | 2085N0700X (Licence: NY 147116-1) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2014-03-04 |