| NPI | 1952962409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0018387) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 335083) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2025-10-10 |