| NPI | 1629368519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 291680) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 311432) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2021-06-22 |