| NPI | 1417039041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 44020) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 162742) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2018-12-01 |