| NPI | 1376667808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 56363) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 236151) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI CMD16239) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2026-08-12 |