| NPI | 1780665851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD20122) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0044877) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 185036) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2021-06-21 |