| NPI | 1710162011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 245501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 245501) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD491942) | |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2025-10-01 |