| NPI | 1205826609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: DC MD33578) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 241191) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD33578) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2025-05-20 |