| NPI | 1295784585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 201153) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C52279) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NV 12849) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2009-03-04 |