| NPI | 1619945342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 204079) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C2-0024581) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA 20A23546) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-07-10 |