| NPI | 1124480173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101265344) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 318887) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2025-06-30 |