| NPI | 1609830132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 292536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 227394) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2022-06-22 |