| NPI | 1134640253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD476931) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 323110) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2024-09-11 |