| NPI | 1740818087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1022415) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 337356) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-12-07 |