| NPI | 1730118076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 079764) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 79764) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-06-29 |