| NPI | 1255621462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A144870) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D79492) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 261899-1) | |
| Enumeration Date | 2011-04-10 |
| Last Update Date | 2020-11-20 |