| NPI | 1770901738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 304179) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 62990) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2023-04-29 |