| NPI | 1770874265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME142037) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 287007) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2023-04-21 |