| NPI | 1114165149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 241901) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A121313) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MA 241901) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A121313) | |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2022-08-31 |