| NPI | 1003892928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 178096) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-53140) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-10-02 |