| NPI | 1902204977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 283687) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD 1136666) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2016-09-12 |