| NPI | 1710254867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 050696) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 268810) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2026-08-24 |