| NPI | 1013975283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301055186) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 270451) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-07-07 |