| NPI | 1790009041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D73614) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 245921) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249275) | |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2022-03-30 |