| NPI | 1972034361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 297402-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD30420) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 39359) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-05-27 |