| NPI | 1053930891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1023000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 336885) |
| Enumeration Date | 2020-04-12 |
| Last Update Date | 2025-10-23 |