| NPI | 1467835769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS17534) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 322724) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2026-02-20 |