| NPI | 1760468193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 228219) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7110) |
| Enumeration Date | 2005-12-18 |
| Last Update Date | 2018-03-14 |