| NPI | 1063498418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200700335) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NC 200700335) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 12626) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 227556) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 29892) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2017-12-20 |