| NPI | 1558303438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 166212) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 166212) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2015-05-27 |