| NPI | 1770583619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 119336) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: VT 0420008367) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-08 |