| NPI | 1497982987 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA P-239096) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 334429) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2025-01-10 |