| NPI | 1043473739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KY 60454) |
| Additional Taxonomies | 2085R0001X (Licence: SC 35282) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 253883) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2025-03-21 |