| NPI | 1851386411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 243049-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G88066) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 77057) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2021-09-21 |