| NPI | 1912906256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 128699) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: NY 128699) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2013-03-08 |