| NPI | 1497374086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 312659) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MB11761200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 312659) | |
| 208D00000X General Practice (Licence: PA OS21496) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS21496) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-09-10 |