| NPI | 1730525643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: ND 18225) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D87764) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 283493) | |
| 2085N0700X (Licence: NY 283493) | |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: OH 35.138281) | |
| 2085N0700X (Licence: NJ 25IA13182100) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25IA13182100) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.138281) | |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MD D87764) | |
| Enumeration Date | 2013-05-18 |
| Last Update Date | 2026-08-24 |