| NPI | 1134356454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 299110) |
| Additional Taxonomies | 2085N0700X (Licence: MD D93193) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD464234) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269112) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D93193) | |
| 2085N0700X (Licence: PA MD464234) | |
| 2085N0700X (Licence: MA 269112) | |
| 2085N0700X (Licence: NY 299110) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2025-09-25 |