| NPI | 1679792998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 248297) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 231173) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD12428) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2008-10-02 |