| NPI | 1417955725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 130143) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 019542) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2016-03-22 |