| NPI | 1033350814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME147397) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 256314) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2024-01-29 |