| NPI | 1487760351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS009864L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 202243) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 20224301) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-07-28 |