| NPI | 1154778421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX T1066) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX T1066) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 68720) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D85801) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 55556) | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2023-12-06 |