| NPI | 1801814249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 265228) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301063585) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 54888) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-11-11 |