| NPI | 1184754384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS13096) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 61761) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: FL OS13096) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 2OA8588) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-05019) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2021-11-01 |