| NPI | 1871856815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463821) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 288977) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2018-11-08 |