| NPI | 1629022280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200400533) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230005-1) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 40305) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2017-12-20 |