| NPI | 1417924408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 209920-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 209920) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2023-06-28 |