| NPI | 1952763575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0017165) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 312547) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-04-22 |