| NPI | 1417942269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60535991) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 223796) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2019-08-02 |