| NPI | 1255345344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301103713) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 231435) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-04-30 |