| NPI | 1851383343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 206039-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101279406) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 206039-1) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2023-08-01 |