| NPI | 1316500937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 24957) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD495958) |
| 207R00000X Internal Medicine (Licence: TX BP10067101) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX BP10067101) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME174871) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR.0006940) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2026-09-29 |