| NPI | 1336153345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200301340) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 26482) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 224969) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD071482L) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-10-18 |