| NPI | 1164414157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55546) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NY 171124) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 171124) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2021-03-03 |