| NPI | 1386891182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A142050) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 264849) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264849) | |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2016-05-26 |