| NPI | 1952549644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 270540) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS20405) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ND 21991) | |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2025-06-04 |