| NPI | 1912275587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 267205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D71693) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2012-10-23 |