| NPI | 1841290418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 235647) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD015244E) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2012-07-24 |