| NPI | 1457643272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0013864) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101253904) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 345480) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2026-08-07 |