| NPI | 1922087816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 170383) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 170383) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2014-04-03 |