| NPI | 1053842989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 315219) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 45540) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2025-0711) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 70408) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2025-06-26 |