| NPI | 1114244837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD466267) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D79280) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 296756) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2021-03-04 |