| NPI | 1811041031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q6787) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 240500-1) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-01-05 |