| NPI | 1992716054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME69620) |
| Additional Taxonomies | 2085N0700X (Licence: NY 2433853) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 2433853) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2026-04-16 |