| NPI | 1740622455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 297868) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 93162) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2024-10-31 |