| NPI | 1063490266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 179507) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NY 179507) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME94695) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-01-11 |