| NPI | 1306828744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2009021866) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 223707) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2016-03-24 |