| NPI | 1033555073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME154061) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 276664) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2022-02-22 |