| NPI | 1225296411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME112206) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 265156) |
| Enumeration Date | 2008-05-25 |
| Last Update Date | 2025-10-26 |