| NPI | 1255642625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD457080) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 283003) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q8253) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-03-05 |