| NPI | 1356413785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101269924) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 220661) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2024-03-25 |