| NPI | 1225054083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 057250) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 224067) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-01-13 |