| NPI | 1396711966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: VT 042-0011749) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 224406) |
| 2085N0700X (Licence: VA 0101263416) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011749) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-04-23 |