| NPI | 1861498537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 175062) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 032665) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2016-06-22 |