| NPI | 1720347073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD213557) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 282000) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 63449) | |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2023-02-03 |