| NPI | 1750335626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60555462) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 240146-1) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2017-04-11 |