| NPI | 1851365944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 21821) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 192057) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 29031) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-11-09 |