| NPI | 1235380825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P4513) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: IA 39813) |
| 2085P0229X Radiology Pediatric Radiology (Licence: IA 39813) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: IA R-8491) | |
| 2085B0100X Radiology Body Imaging (Licence: IA R8525) | |
| 2085N0700X Radiology Neuroradiology (Licence: IA R8780) | |
| 2085B0100X Radiology Body Imaging (Licence: IA 39813) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2012-12-17 |