| NPI | 1730316191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 327878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240420) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A113177) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2024-08-13 |