| NPI | 1699933200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101273787) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 249406) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2023-03-21 |