| NPI | 1295995108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: NY 269920-1) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 269920-1) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2019-10-01 |