| NPI | 1588660591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 110140) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 017107) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2011-10-21 |