| NPI | 1477624864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD434413) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230615) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2019-03-07 |