| NPI | 1740845601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 323285) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A200925) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U8695) | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-07-15 |