| NPI | 1528052123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 211094-1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 211094) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2015-05-11 |