| NPI | 1902250442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 317509) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A153194) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2022-06-27 |