| NPI | 1700092129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2008-00896) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 34117) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 256318) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2017-12-20 |