| NPI | 1992261887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 302949) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VT 042-0014354) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX V1396) | |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2024-07-18 |