| NPI | 1366433740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7672) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 263188) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2013-09-19 |