| NPI | 1790952109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0070517) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 234650) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2019-04-24 |