| NPI | 1508246273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 331260) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT208875) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2024-11-27 |