| NPI | 1215106455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C202882) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA L-228909) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260836) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD447211) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0070348) | |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2026-04-02 |