| NPI | 1821097445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 216752) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME112393) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 203890) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2018-04-09 |