| NPI | 1639304900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD436070) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 003305-1) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2009-05-15 |