| NPI | 1457459711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 232866) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 229441) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-11-08 |