| NPI | 1144457789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME136947) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 52861) |
| 2085P0229X Radiology Pediatric Radiology (Licence: DE C1-0012738) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2022-10-18 |