| NPI | 1649860511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD223054) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101284297) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 333425) | |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2025-10-31 |