| NPI | 1932208568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G88069) |
| Additional Taxonomies | 174400000X Specialist |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 134786-1) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-10-08 |