| NPI | 1891229001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 329860) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND PT21129) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-07-03 |