| NPI | 1639448020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 269513) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO1899) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2014-09-16 |