| NPI | 1831392372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NY 261851) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 261851) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 261851) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2013-10-02 |