| NPI | 1194754259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 36847) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 239944) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-09-03 |