| NPI | 1023371952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 270314) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME164505) |
| 2085N0700X (Licence: DE C1-0012565) | |
| 2085N0700X (Licence: PA MD463724) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0012565) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463724) | |
| 2085N0700X (Licence: NJ 25MA10286200) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10286200) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2026-04-30 |