| NPI | 1073649653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 230761) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD11955) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 340905) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2025-12-19 |