| NPI | 1114362134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A170607) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 298168) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2025-02-27 |