| NPI | 1942732300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD227220) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 314838) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-12-09 |