| NPI | 1558717132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: NC 2022-01577) |
| Additional Taxonomies | 2085N0700X (Licence: VA 0101274921) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01577) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101274921) | |
| 2085N0700X (Licence: SC 87880) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 87880) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 309544) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2025-10-03 |