| NPI | 1578856613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME130165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199311) |
| 2085N0700X Radiology, Neuroradiology (Licence: GA 8884) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54050) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2024-01-09 |