| NPI | 1710397567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 306546) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 63717) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2022-01-27 |