| NPI | 1619154101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 47721) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 236126) |
| 2085B0100X Radiology, Body Imaging (Licence: NY 236126) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2026-03-25 |