| NPI | 1609586783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 344049) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 292508) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2026-05-27 |