| NPI | 1346462629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 235434) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 235434) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 235434-1) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-06-25 |