| NPI | 1831417856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME155868) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NY 274042) |
| 207R00000X Internal Medicine (Licence: PA MT194736) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 274042) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2022-07-08 |