| NPI | 1992776033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD008400E) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 130260-1) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2008-03-28 |