| NPI | 1215101167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 110406) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0054593) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CA 110406) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CO DR.0054593) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2023-09-19 |