| NPI | 1790752806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 216663) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 216663-1) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2023-10-05 |