| NPI | 1639505142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MD 97-196) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD494778) |
| 2085N0700X (Licence: KY 59332) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2026-05-14 |