| NPI | 1730472689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101262570) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 284146) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2017-10-24 |