| NPI | 1881884658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A95479) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2005000620) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 233527-1) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2007-07-27 |