| NPI | 1568813350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 310597-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268586) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2023-05-01 |