| NPI | 1699166702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 330656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A152654) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2024-08-21 |