| NPI | 1518158799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 265077) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP1-0029108) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N4881) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2012-06-14 |