| NPI | 1568181667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0109542118) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NY P114929) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2023-06-28 |