| NPI | 1518174978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 240310) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D67284) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2015-01-07 |