| NPI | 1578591319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G87424) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R8E95) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 254343) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2025-07-07 |