| NPI | 1215440342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101267382) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0116032474) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 351443) | |
| 225100000X Physical Therapist (Licence: NY 022223) | |
| Enumeration Date | 2017-11-11 |
| Last Update Date | 2026-04-24 |