| NPI | 1245478486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 258634) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MD D68670) |
| 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA08034300) | |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2010-09-13 |