| NPI | 1922315472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A131555) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 267176) |
| Enumeration Date | 2010-09-04 |
| Last Update Date | 2020-02-11 |