| NPI | 1295120541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 334713) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2023011716) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2025-06-17 |