| NPI | 1366071516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 5671280) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 329045) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-06-10 |