| NPI | 1669977476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 328400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2023-02048) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME170740) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-10-10 |