| NPI | 1831164631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD421392) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 135313) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2007-07-08 |