| NPI | 1154959948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: NY 311890) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 35267) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD29610) | |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2025-12-04 |