| NPI | 1225422504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 305343) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 68236) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD478655) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2023-08-21 |