| NPI | 1922594019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 320557) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 276461) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 1015624) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-05-09 |