| NPI | 1912997115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0060281) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264867) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2019-02-08 |