| NPI | 1366413734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 097861) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 097861-1) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2011-08-24 |