| NPI | 1922446756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME183088) |
| Additional Taxonomies | 2085N0700X (Licence: NY 315913) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11498000) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2026-08-04 |