| NPI | 1124550561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160987) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 315629) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2024-05-30 |