| NPI | 1861450611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 231404) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 000000) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2020-03-05 |