| NPI | 1871722801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 274286-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS14837) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2023-06-08 |