| NPI | 1831167261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 242442) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47796-21) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2008-06-03 |