| NPI | 1215992300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 239108-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL me53528) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2013-12-23 |