| NPI | 1699767707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 173758) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61497216) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME147948) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-08-30 |