| NPI | 1235523291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A160226) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 322999) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD491192) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2025-11-06 |