| NPI | 1134563844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 322410) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 59984) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28559) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2023-06-27 |