| NPI | 1154316669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 2591381) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 259138) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2023-07-06 |