| NPI | 1255692935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A149455) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 312462) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2024-03-13 |