| NPI | 1316508567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 311110) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04756) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2026-02-13 |