| NPI | 1952918203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76718) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 303829) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2024-10-07 |