| NPI | 1639369150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 237757) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30090) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD19449) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2024-05-23 |