| NPI | 1134110281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C170859) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 232947) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2026-04-22 |