| NPI | 1952347890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 142692-1) |
| Additional Taxonomies | 2085N0904X (Licence: NY 142692-1) |
| 2085N0904X (Licence: MO 32695) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2008-08-06 |