| NPI | 1952300964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 214318) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: NY 214318) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2018-04-09 |