| NPI | 1790096592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C181443) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 57202) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 321712) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2025-11-02 |