| NPI | 1881011930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 316349-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A161371) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-21325) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-03-27 |