| NPI | 1265461610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: LA 311706) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NY 225637) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 225637) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: LA 311706) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-02-20 |