| NPI | 1609843903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NY 204420) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 204420) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 80739) | |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2021-08-06 |