| NPI | 1619389566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C209186) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 334233) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019012536) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2026-05-27 |