| NPI | 1811384027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 309867) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D89333) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2023-05-30 |