| NPI | 1053996314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD600004157) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DC MD600004157) |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2025-10-23 |