| NPI | 1205801024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD041395E) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 174288-1) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2011-07-29 |