| NPI | 1003014473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD439457) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 340911-01) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 083372) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2025-12-15 |