| NPI | 1871559591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301085312) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 171840-1) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2020-05-05 |