| NPI | 1861782112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: KY TP807) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NY 258538) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 258538) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2022-06-10 |