| NPI | 1306852504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1013573) |
| Additional Taxonomies | 2085N0700X (Licence: NY 2477621) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277389) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 2477621) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A108805) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2026-08-03 |