| NPI | 1578536876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 192746-1) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD072317L) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2021-04-02 |