| NPI | 1508035486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 200157) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 238458) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME103277) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2017-02-08 |