| NPI | 1417942129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 44121) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 44121) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 117208) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2013-09-24 |