| NPI | 1982818373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1015001) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 238696) |
| 2085N0904X (Licence: MA 1015001) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101259946) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2026-02-19 |