| NPI | 1639184377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 045213) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY None) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD15884) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2026-08-26 |