| NPI | 1588713499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD434337) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 25MA08447100) |
| 2085N0700X (Licence: PA MD434337) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD434337) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08447100) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2026-05-13 |