| NPI | 1982845350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101259235) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 275813) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2021-03-09 |