| NPI | 1639330533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD83942) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116020239) |
| 2085B0100X Radiology Body Imaging (Licence: MD D75539) | |
| 2085B0100X Radiology Body Imaging (Licence: MA 242355) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WV 27369) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 71819) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD483942) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2024-05-02 |