| NPI | 1356542187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A117967) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 261661) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2013-04-22 |