| NPI | 1275869729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 269134) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD461171) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 306688) | |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2024-03-04 |