| NPI | 1730491192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD444860) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 245925) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2012-11-01 |