| NPI | 1669464780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 206239) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NY 206239) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-06-09 |