| NPI | 1477787968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 258794) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2014007661) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0061336) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2023-03-28 |