| NPI | 1598323784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 335456) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 77670) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2025-07-18 |