| NPI | 1093004939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D88844) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 278867) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301508236) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: PA TMD005113) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MD D88844) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD455929) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA TMD005113) | |
| 208D00000X General Practice (Licence: MA 278867) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2024-06-24 |