| NPI | 1770765729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120747) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 256621) |
| Enumeration Date | 2007-12-02 |
| Last Update Date | 2021-08-11 |