| NPI | 1922256650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: TX R9329) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 101263636) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 341444) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME142124) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD436037) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0101641) | |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2026-01-23 |