| NPI | 1619161114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME 130900) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 251992) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD 435937) | |
| 208D00000X General Practice (Licence: FL 103900) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2023-06-29 |