| NPI | 1558098293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 328213) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022028641) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023016180) | |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2024-02-29 |