| NPI | 1780908368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 246245) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C202202) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2025-08-04 |