| NPI | 1508863879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME103162) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 193025) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2024-01-08 |