| NPI | 1861705253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 284197) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MA 262437) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2017-05-11 |