| NPI | 1063620540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016886) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 295654) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-11-12 |