| NPI | 1003851726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 222637) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101281884) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301512042) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2018-0643) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2025-07-10 |