| NPI | 1417020967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0067803) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 241402) |
| 2085N0700X Radiology, Neuroradiology (Licence: MD D0067803) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-08-23 |