| NPI | 1245251875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 173012) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME151246) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 032058) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-03-10 |