| NPI | 1457673956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A111204) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 241639) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2015-01-13 |