| NPI | 1225151343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: NY 301881) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 231092) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 231092) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 301881) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-03-02 |