| NPI | 1366651614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 266252) |
| Additional Taxonomies | 2085N0700X (Licence: VA 0101239931) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2026-04-15 |