| NPI | 1326036559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 239607-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS9538) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 1276) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2025-12-05 |