| NPI | 1720392905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 255425-1) |
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: NY 255425) |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2023-07-07 |