| NPI | 1396272472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102207209) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 323588) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2025-12-12 |