| NPI | 1962662783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 262851) |
| Additional Taxonomies | 2085N0700X (Licence: NY 262851) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2014-11-04 |