| NPI | 1316924020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 202020) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 202020-1) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2014-04-03 |