| NPI | 1336180363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 09950) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 101829) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-11-19 |