| NPI | 1518915941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 186427) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 40800) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-05-04 |