| NPI | 1235121336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101283528) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 222722) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-09-17 |