| NPI | 1063654531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME127880) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C10011705) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD457702) | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2018-01-12 |