| NPI | 1093163537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 315810) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 267912) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2022-07-13 |