| NPI | 1336392810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 268457) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301093860) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2014-03-27 |