| NPI | 1902070519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A104502) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 245863) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2021-07-08 |