| NPI | 1518209675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-01467) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 294990) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2025-06-19 |