| NPI | 1902029119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 048456) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 233043-1) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2012-07-20 |