| NPI | 1336482702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 19019) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 276884) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2019-10-07 |