| NPI | 1912968025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 170764) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2214) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.083869) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD420326) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2023-05-11 |