| NPI | 1184060576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D86994) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 309048) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2021-07-22 |