| NPI | 1659785665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: FL ME149072) |
| Additional Taxonomies | 2085N0700X (Licence: NY 288516) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 288516) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD600004034) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2025-05-22 |