| NPI | 1023091972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 23222) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 169226) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2025-11-12 |